311 - Implementation of PALS in a Level IV NICU

Poster Number: 311
Publication Number: 311.347

Sandeep k. chilakala, University of Tennessee Health Science Center College of Medicine, Germantown, TN, United States; Ajay J. Talati, UTHSC, Memphis, TN, United States; Mark F. Weems, University of Tennessee Health Science Center, Memphis, TN, United States

Background: Neonatal Resuscitation Program (NRP) originally designed to support the transitional physiology in the delivery room has extended to Neonatal Intensive Care Unit (NICU) and beyond. NRP focuses on ventilation as the likely etiology of arrest in newborns is respiratory failure. Level IV NICUs admit infants with complex cardiac and medical conditions with extended stay up to several months. NRP may not be ideal in resuscitating such infants. Pediatric Advanced Life Support (PALS) focus on resuscitation through cardiac compressions. There is lack of agreed upon criteria for implementation of PALS in the NICU. For cardiopulmonary resuscitation (CPR) events in our NICU, we implemented guidelines for using PALS algorithm

Objective: To evaluate the implementation of PALS during CPR in infants with PMA ≥ 48 weeks, with etiology of arrest cardiac in origin, and infants with major congenital heart defects at a level IV NICU. Compliance to new guidelines, understand the contributing factors, understanding the effectiveness of guidelines and preferred learning methods for providers was also evaluated

Design/Methods: CPR events at the LeBonheur Children’s NICU between Aug 2022 until Dec 2022 were identified and divided in to two cohorts. PALS cohort consisted of CPR events who qualified under new guidelines and rest included in the NRP cohort. Code records were reviewed retrospectively. Demographics, resuscitation methods, interventions, and outcomes, were recorded and compared. A 27-questionnaire survey was sent to 37 NICU providers after implementation and responses noted

Results: 27 CPR events were identified of which,12(44%) had PALS and 15(56%) received NRP. Table 1 shows GA, PMA, etiology, duration of CPR, epinephrine use and survival outcomes between the two groups. PALS group had significantly higher PMA at arrest. NRP group had significantly higher use of epinephrine. Immediate survival in PALS group is significantly higher. Other variables were similar. No shockable rhythms were identified.15% of the total infants qualified for PALS during the study period. 100% of the qualified infants received CPR by PALS algorithm. Provider survey had 28 responses (75.6%) and characteristics are in Fig 1.Results indicate (Fig 2) 50% are comfortable leading PALS code and 100% are comfortable with NRP. 87.5% agree that PALS mock codes are beneficial

Conclusion(s):

We were able to successfully implement PALS algorithm in an NICU for qualified infants. Provider comfort needs to be improved by reeducation and frequent mock codes. Simulation-based training could help in timely appropriate resuscitation and avoid variation